BEUDAMED
    FDA Adverse Event Injury Summary report: N

    MEDTRONIC

    MDR report key: 753845 · Received August 9, 2006

    Report

    Report Number
    MW1040001
    Event Type
    Injury
    Date Received
    August 9, 2006
    Date of Event
    July 12, 2006
    Report Date
    August 8, 2006
    Manufacturer
    MEDTRONIC
    Product Code
    LWS
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    MN, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    APPARENT LEAD FRACTURE AND MULTIPLE SHOCKS. PT CAME IN W/OVERSENSING OF RV LEAD. LEAD REVISION THE NEXT DAY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MEDTRONIC * LWS MEDTRONIC 6949 *

    Patients

    Seq Age Sex Outcome Treatment
    1 48 YR Required Intervention